Look up the most recent NPI and PECOS records

Justin Anthony Medina

Internal Medicine

Allopathic & Osteopathic Physicians

PECOS Enrollment

This provider is enrolled in PECOS as JUSTIN MEDINA.

Based on the most recent information from CMS, provider Justin Anthony Medina is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1245807262
Provider Type
Individual
Full Name
Medina, Justin Anthony
Title
Mr.
Credential
M.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
6/8/2021
Last Updated
1/20/2024

Contact Information

Practice Location

1611 NW 12th Ave, Miami, FL 33136

(305) 585-7341

Unlisted Fax

Mailing Location

1611 NW 12th Ave, Miami, FL 33136

(868) 772-2675

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 98442 Georgia
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Justin Anthony Medina

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Pavon Canseco, Aldo

Harlamova, Oxana

Mendez, Paul E

Zaw, Khin M

Corredera, Erica

Van Kirk, Kendra Michelle

Berbel Caban, Ana Beatriz

Rubin, Phillip

Laban, Joshua Noel

Suarez Zarate, Sebastian